Constipation is a very common problem and can be experienced by 1 in 3 children. There are lots of possible triggers but some of the main causes are:
- around the time of potty-training
- when there is a diet change (moving onto milk formulas, weaning onto solids)
- when there is a significant change (such as starting daycare or the birth of a new sibling)
- allergies
- dehydrating sickness or surgery (many pain killers slow the gut down)
- fear of toilets or poo after a stressful event.
Constipation is unlikely to go away by itself and is considered a medical problem and needs to be treated properly and promptly to stop it getting worse. If you have any concerns that your child may be constipated, the first step is to consult with your doctor who will be able to assess and recommend treatment options.
Constipation can be seen when:
- there are 3 or less poos in a week. Ideally, children should pass some soft poo every day, or at least every other day.
- poos are passed more than 3 times a day. This can indicate that their bowel is full or that they are not waiting and emptying the whole poo when they poo – so there is more to come out later in that day.
- there is ‘soiling’, ‘skid marks’ or accidents. Soiling occurs when poos are released from the rectum at unexpected times. There may be hard bits of poo, soft or even liquid poo. Liquid poo related to constipation is called ‘overflow’ and is common in a condition called encopresis. Sometimes soiling might be a lot or just a little bit – any amount indicates that the bottom is not empty and the child needs to go and empty.
- the child is actively avoiding pooing; referred to as retention or withholding. The child works hard to avoid letting the poos out and you may observe postures/body movements that indicate the child is trying to keep the poo in. This can result from a memory of painful or hard poo in the past and now they are fearful of letting the poo go.
- the poo is putrid – poo that looks like little dry pellets or rabbit droppings, may be dark in colour and is much smellier than healthy poo.
- large and hard poos, or lots of poo all at once; some clients describe poos that block the toilet bowl.
Why do kids get constipated?
There are many different causes of constipation in children. Sometimes there can be one or more causes and it may be difficult to find just one obvious reason. This is where your doctor together with a Continence trained health professional such as a nurse, physiotherapist, occupational therapist or dietician can be helpful.
- Most children have what is termed ‘functional constipation’. This means that there’s no known physical cause. Their bowel works properly, but for some reason they have become constipated.
- There may be an underlying problem with differences in the bowel structure or mechanism (e.g. food allergy). See your medical practitioner if you suspect this, or the child had problems pooing even before they attempted toilet training.
- Insufficient daily water intake or dietary differences that limit a well-balanced diet with poos becoming hard to pass. An illness / virus can cause dehydration, and some medications can have a constipation effect such as iron supplements and pain medication.
- Children with low muscle tone, hypermobility, anxiety, ASD or ADHD are more likely to experience constipation.
- Children with difficulties noticing body sensations and feeling overwhelmed with their sensory environment (smell, sound, lighting in toilets) are more likely to experience constipation. For example, hand dryers in public toilets can be a real fear for some children who are frightened of the unexpected noise. As a result, they avoid using toilets outside their home and can become constipated during school terms or away on holidays.
- Children can also become very focused on an interesting activity, and as a result may postpone the need to use the toilet and then over time experience constipation.
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- Life changes such as a house move, a new baby in the home, starting potty training, starting school (using the school toilets) or feeling worried about something. When children feel anxious it can be hard for them to relax completely on the potty or toilet to let all of their poos out.
What Can We Do?
Encourage your child to check their poos every day. This is such a healthy body skill and can help us identify what our bodies need. Here at Kids That Go Therapies we use the Bristol Stool Scale (Ref: https://www.continence.org.au/bristol-stool-chart) to check poo type and what it means:
Helpful References and Resources: https://www.rch.org.au/kidsinfo/fact_sheets/constipation/
https://www.continence.org.au/
https://eric.org.uk/ – click on Advice for children with constipation which has more information, including a downloadable PDF.
Parent webinar presented by Rebecca Khan, ‘Video Resource Pack: Constipation & Soiling‘.
As Occupational Therapists, we can also help your child through developing their toileting skills and maintaining a healthy bowel.
ROS PULLMAN
Occupational Therapist
Learn more from some of our other toileting blogs:
- How can Occupational Therapy help my child use the toilet?
- My tummy is sore: learning about abdominal pain
- How squatting can help your child poo
- 3 of our favourite toileting tips for kids
